类风湿性关节炎患者间质性肺疾病的临床概况

Interstitial lung disease in patients with rheumatoid arthritis

目的了解类风湿性关节炎肺间质病变的发生情况、特征及相关因素分析，以便早期发现类风湿性关节炎的肺部病变。方法类风湿性关节炎患者45例，免疫比浊法检测类风湿因子、C反应蛋白、免疫球蛋白及补体；间接免疫荧光法和免疫印迹法检测抗核抗体及亚类。血气分析测定氧分压、动脉血二氧化碳分压和肺泡-动脉血氧分压差。肺功能仪测定潮气容积、最大肺活量、用力肺活量、第1秒用力呼气容积、最大呼气中段流量、最大通气量和一氧化碳弥散功能。放射学检查包括胸部正侧位X线片、双手像和肺高分辨率CT扫描。结果45例类风湿关节患者中，14例存在肺间质病变，其中10例有呼吸道症状。肺功能检测异常主要为弥散功能降低和限制性通气障碍。8例胸部X线片存在异常，14例高分辨率CT发现异常。肺高分辨率CT在发现类风湿性关节炎肺间质病变病变时优于普通胸部X线片。结论类风湿性关节炎肺间质病变的发生与疾病活动性和严重性相关，肺弥散功能、高分辨率CT在早期发现病变时有诊断意义。

Objective To investigate the prevalence and clinical manifestation of rheumatoid arthritis-interstitial lung disease（RA-ILD）. Methods Forty-five inpatients with rheumatoid arthritis（RA） were enrolled. Serum rheumatoid factor （RF） , C reactive protein （CRP） , immunoglobulin （IgG, IgA, IgM） , and compliment （C3, C4 ） were measured by immunonephelometry. Antinuclear antibodies （ANAs） and anti-extractable nuclear antigen（ anti- ENA） antibodies were measured by indirect immunofluorescence technique and Western blot. Arterial gas analysis included PaO2, PaCO2, and PA-a O2. The following pulmonary function tests were performed： tidal volume（VT）, maximal vital-capacity （ VCmax ） , forced vital capacity （ FVC ）, one second forced expiratory volume （ FEV1 ）, FEV1/FVC, maximal mid-expiratory flow（MMFF） , maximal voluntary ventilation （MVV） and diffusing capacity CO （DLCO）. Radiology examinations included chest X radiographs, hand radiographs and chest HRCT. Results ①The incidence of RA-ILD was 31.1%. RA-ILD frequently occurred in old male with long disease history. ②The damage of lung function was mainly decreased DLCO and restricted ventilatory function abnormalities. ③HRCT abnormal findings included interlobular septal thickening, bronchovascular bundles thickening, sub pleural lines, reticular appearances, ground glass capacity and honeycomb changes. HRCT was more sensitive than chest radiography. Conclusions The incidence of RA-ILD is associated with the activity and severity of RA. DLCO and HRCT are important for early detection of disease.